What We Don't Know About Suicide

Matthew Herper
,
Forbes Staff
I cover science and medicine, and believe this is biology's century.

CNNMoney reports that Ilya Zhitomirskiy, one of four co-founders of the social networking site Diaspora, died over the weekend, and that suicide was the likely cause of death. He was 22.

Zhitomirskiy committed suicide, a source close to the company told CNNMoney on Sunday.

A San Francisco Police Department officer confirmed on Monday that a police report about Zhitomirskiy's death says officers responded to the 700 block of Treat Avenue around 8:10 p.m. on Saturday. The department had received phone calls about a possible suicide.

The case was then referred to the medical examiner's office, said SFPD Officer Alvie Esparza.

"In this case it appears to be a suicide," Esparza added. "However, the medical examiner's office will make the final decision" after conducting testing.

You can't overstate how terrible that is. Here is the grim fact about suicide: this is a health problem that claims 35,000 lives a year that we don't understand, and that we are not trying hard enough to understand. We don't know why people kill themselves, and that fundamental fact means that we are not very good at preventing tragedy.

Forbes dove deep into this problem in a wonderful piece last year called "The Forgotten Patients." Authors Robert Langreth and Rebecca Ruiz wrote:

Roughly 35,000 Americans commit suicide each year--more than die from prostate cancer or Parkinson's disease. Another 1.1 million people make attempts, while 8 million have suicidal thoughts. Among those aged 15 to 25 it is the third leading cause of death. Yet researchers know astonishingly little about how to treat people who contemplate killing themselves. The subject has been so roundly ignored that the 900-page bible of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders IV, offers no advice for doctors on how to assess suicide risk.

Fear, logistics, low research funding and more risk than reward for drug companies all conspire to make suicide the neglected disease. The National Institutes of Health is spending a paltry $40 million in 2010 studying suicide, versus $3.1 billion for research on aids, which kills half the number of Americans. (Another government agency spends $48 million on hotlines and prevention.) Therapists often don't want to treat suicidal patients, and university clinical study review boards are skittish about studying them, says the University of Washington's Linehan.

"You would think it would be bread and butter for psychiatry," Harvard Medical School psychiatrist Ross Baldessarini told Forbes. "But the therapeutic research has been very limited." When he organized a conference on the subject in the 1990s, "nobody had anything to say," he recalls. Columbia University psychologist Barbara Stanley says, "It is one of the most under-researched areas in all of psychiatry."

Another piece of recommended reading: this 2003 New Yorker piece on efforts to reduce the number of people jumping from the Golden Gate Bridge. The sad message there: that if you can keep people from killing themselves, they will get through their troubles and survive. This is an area where medicine should be able to do much, much better.